Optimization of Staging of the Neck With Prophylactic Central and Lateral Neck Dissection for Papillary Thyroid Carcinoma

Hartl, Dana M.; Leboulleux, Sophie; Ghuzlan, Abir Al; Baudin, Éric; Chami, L.; Schlumberger, Martin; Travagli, Jean-Paul

doi:10.1097/sla.0b013e31824b7b68

Cited by 159 publications

(142 citation statements)

References 45 publications

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“…Those who argue for a pCND cite the high rates of occult disease (as for the lateral neck) and highlight the fact that this additional knowledge allows patients to be more accurately risk stratified for the targeting of adjuvant RAI [37]. In addition, re-operative central neck surgery is associated with higher risks than an initial procedure.…”

Section: Surgery For Regional Lymphaticsmentioning

confidence: 99%

Wysoko zróżnicowany rak tarczycy — czy nie leczysz swoich pacjentów zbyt intensywnie?

Nixon

2016

Endokrynologia Polska

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Over the last 50 years there has been a move towards more aggressive therapy for well-differentiated thyroid cancer. In recent times, however, international guidelines have shown some trend back towards a more conservative approach to treating low-risk patients. This review explores how the state of the art in well-differentiated thyroid cancer research has evolved in tandem with improvements in riskstratification. A focus on the surgical approach to the primary thyroid tumour and the regional lymphatics in addition to the interplay between surgical decision making and the use of radioactive iodine are presented to allow the reader to determine whether they are now overtreating patients with well-differentiated thyroid cancer. StreszczenieW ciągu ostatnich 50 lat nastąpiła zmiana w leczeniu wysoko zróżnicowanego raka tarczycy na rzecz bardziej agresywnej terapii. Jednakże, całkiem niedawno, międzynarodowe wytyczne wskazały trend w kierunku powrotu ku bardziej konserwatywnemu podejściu w leczeniu pacjentów niskiego ryzyka. W niniejszym artykule opisano jak najnowsze badania na temat wysoko zróżnicowanego raka tarczycy ewoluują równocześnie z ulepszeniami w stratyfikacji ryzyka. Podejście chirurgiczne do raka pierwotnego tarczycy oraz regionalnych węzłów chłonnych przedstawiono wraz ze wzajemnymi zależnościami operacyjnego procesu decyzyjnego i wykorzystaniem radiojodu, aby umożliwić czytelnikowi ustalenie, czy zbyt intensywnie leczy pacjentów z wysoko zróżnicowanym rakiem tarczycy.

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Section: Surgery For Regional Lymphaticsmentioning

confidence: 99%

Wysoko zróżnicowany rak tarczycy — czy nie leczysz swoich pacjentów zbyt intensywnie?

Nixon

2016

Endokrynologia Polska

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“…60) However, even expert groups report complication rates as high as 50% following total thyroidectomy and lateral neck dissection, including hypocalcemia (30%), chronic neck pain (30%), chyle leak (3%) and recurrent laryngeal nerve palsy (10%). 61) There have been many studies suggesting that prophylactic lateral node dissection has little or no effect on improving the prognosis of patients with PTC.…”

Section: Lateral Neck Dissectionmentioning

confidence: 99%

“…Therefore, the ATA recommended a comprehensive selective neck dissection of levels IIa, III, IV, and Vb. 59) In comparison with the central compartment, the lateral neck harbors lower rates (23%) 60) of occult metastasis and elective surgery results in higher postoperative complication rates. Despite this, some experts continue to advocate selective prophylactic lateral neck dissection.…”

Section: Lateral Neck Dissectionmentioning

confidence: 99%

Regional Lymph Node Metastasis in Papillary Thyroid Cancer

Park

Lee

Bae

et al. 2014

J Korean Thyroid Assoc

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Papillary thyroid cancer is a common endocrine cancer and commonly presents with lymph node metastases. It has been generally accepted that lymphatic drainage occurs from the thyroid primarily to the central lymphatic compartment and secondarily to the lateral compartment nodes. Recently, improvements in the resolution of imaging studies and the availability of highly sensitive thyroglobulin assays have highlighted the importance of identifying disease in the pre-operative assessment and dealing effectively with metastatic regional disease in order to prevent recurrence. However, there are limitations to diagnosing central lymph node metastases. With unreliable imaging modalities, prophylactic central lymph node dissection should be performed on all patients with papillary thyroid cancer. In comparison with the central compartment, prophylactic lateral node dissection has little or no effect on improving the prognosis of patients with papillary thyroid cancer. Therefore, lateral node dissection is recommended only as a part of the therapeutic procedure. The extension of lateral neck dissection is recommended a comprehensive selective neck dissection of levels IIa, III, IV, and Vb. The rich lymphatic supply of the thyroid gland coupled with the propensity for nodal metastases in papillary thyroid cancer require the modern thyroid surgeon to be familiar with the indications for and techniques of regional lymph node dissection.

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“…This finding is demonstrated in the work of groups who consider prophylactic surgery mandatory for all cases of PTC irrespective of clinical nodal status (i.e., cN0/cN1). 27 Rates of nodal involvement exceed 40% in many studies even in cN0 cases, reinforcing the need for prophylactic nodal surgery in the minds of both clinicians who adopt 28 This was interpreted by many as official support for prophylactic neck dissection. However, not all authors agreed.…”

Section: Regional Lymph Nodesmentioning

confidence: 99%

Our Understanding of Well-differentiated Thyroid Cancer

Thompson¹,

Nixon²,

Souza³

2017

International Journal of Head and Neck Surgery

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Through significant contributions to our understanding of risk factors, prognostic indicators and management of welldifferentiated thyroid cancer (WDTC), Prof Jatin Shah has contributed much to the field of thyroid cancer in recent times. Many of the guidelines used in WDTC management today are a testament to his less-aggressive, dedicated and individualised approach. This article seeks to both review the current understanding of WDTC and to outline these contributions in a special issue dedicated to the career of Prof Shah.

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Optimization of Staging of the Neck With Prophylactic Central and Lateral Neck Dissection for Papillary Thyroid Carcinoma

Abstract: For staging, bilateral prophylactic CND is preferable to unilateral CND. Prophylactic CND with LND optimizes staging providing a basis for a personalized approach for adjuvant radioiodine.

Cited by 159 publications

References 45 publications

Wysoko zróżnicowany rak tarczycy — czy nie leczysz swoich pacjentów zbyt intensywnie?

Wysoko zróżnicowany rak tarczycy — czy nie leczysz swoich pacjentów zbyt intensywnie?

Regional Lymph Node Metastasis in Papillary Thyroid Cancer

Our Understanding of Well-differentiated Thyroid Cancer

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